Musings in the life of an internist, cardiologist and cardiac electrophysiologist.

Friday, July 25, 2008

I Didn't Practice Evidence-Based Medicine Today

He was 70 with critical aortic stenosis and ejection fraction of 10%, coronary artery disease and history of 5-vessel bypass in 2001, a history of Stage D colon cancer with lung mets resected 18 months ago, obesity, diabetes mellitus, chronic renal insufficiency and was recently extubated after a failed aortic valvuloplasty. He later developed a wide complex tachycardia at 150 beats per minute for which I was asked to consult. The SVT looked just like his underlying left bundle branch block and would start and stop – usually with a PAC. He was administered 2.5mg metoprolol intravenously and loaded with Amiodarone. His SVT became a non-issue thereafter.

But I didn’t check his HbA1c.

I didn’t check his LDL lipid level.

I didn’t do a diabetic fundoscopic exam.

I didn’t refer him to a neurologist for his mild peripheral neuropathy.

I didn’t get him an evaluation of his footwear.

I didn’t give him an implantable defibrillator or biventricular pacemaker.

My experience as an old "detailman" litterally living in doctor's offices,medical schools, hospitals, pharmacies, nursing homes, and clinics for 35 years, has given me a special appreiciation for clinicians who have the ability to practice medicine on this level. I never failed to be impressed when I saw them in action. It is the difference between "paint by the numbers" and a master artist.

As a 4th year medical student, not far from the days when I will be making similar decisions for my patients, I applaud you for noting the absurdity of some of the things we do in medicine. So often I see someone in the unit who is elderly, has esrd, stage 4 cancer (pick your favorite), alzheimers, and someone has the nerve to call a cardiology consult for a heart block... talk about rearranging the deck chairs on the Titanic.

I think that because of there being so many "guidelines" we have to follow, we have begun to practice "Cover Your A** Medicine".

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.